Noteworthy News

GAO Compares Medicaid, Private Insurance Rates

The U.S. Government Accountability Office (GAO) has completed a new study that compares how physicians are paid by Medicaid (both fee-for-service (FFS) and managed care plans) and private insurers.

Looking at payments for 26 different physician evaluation and management (E&M), the agency also compared payments both before and after passage of the temporary increases mandated by the Health Care and Education Reconciliation Act of 2010 (HCERA).

Among the GAO’s findings:

Among the three types of E/M services analyzed (office visits, hospital care, and emergency care), Medicaid payments generally were lower than private insurance for all three types, but the magnitude of the difference was often largest for emergency care and smallest for office visits.

Also,

Within the Medicaid program, managed care payments for E/M services were generally equal to or higher than FFS prior to the HCERA-mandated increases. Specifically, in the 20 states where GAO compared managed care payments to FFS, managed care payments were 0 to 12 percent higher than FFS in 15 states. Managed care payments for emergency care and hospital care were approximately equal to FFS payments in most states, while office visits showed more variation.

The new study is titled Comparisons of Selected Services under Fee-for-Service, Managed Care, and Private Insurance.  A summary of the study and a link to the complete report can be found here.

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